RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00983
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070510

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Dental Assistant, medically separated for “chronic left testicular pain” with a 20% disability rating.  

CI CONTENTION:  Believes there were other conditions deemed service connected by the VA. He also requested the panel review all conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070205	VARD - 20080227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Testicular Pain	5099-5003	20%	Residuals of L Varicocelectomy with Oligospermia	7599-7525	10%	20070214	
Depressive Neurosis	Not Unfitting	Major Depression 	---*	10%	20080130	
GERD 	Not Unfitting 	GERD	---*	NSC	20080126	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	
*VARD codes were not in available records

ANALYSIS SUMMARY:  

Chronic Left Testicular Pain.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI was noted to have an abnormal genito-urinary examination at accession.  He developed left testicular pain during training which led to a urology evaluation on 20 July 1999.  He was determined to have a graded IV varicocele (an abnormal enlargement of the veins that drain the testicle) which had been diagnosed 1 year earlier (presumably at accession).  On 6 August 1999, the CI underwent surgical repair with delayed healing.  On 13 June 2000, he presented with a 3 week history of progressive left testicular pain which led to a second procedure (spermatic vein ligation) on 18 August 2000.  On 6 December 2001 ultrasound examination showed a persistent varicocele but no further surgery or injections (for pain) were recommended.  The record then falls silent until 14 October 2005 when the CI requested another referral to urology.  Pending the evaluation, a trial of conservative treatment including the wear of a good scrotal support, warm water soaks, and minimal examinations was attempted with minimal benefit.  Medications provided some relief from his discomfort which was relatively stable since the second surgery in 2000.  The CI noted increased pain after running, sit-ups, and prolonged standing.  An ultrasound confirmed the presence of a persistent varicocele.  A CT scan of the abdomen and pelvis was unremarkable.  The CI then underwent a 3rd procedure on 3 March 2006.  Following recovery, a significant reduction in the size of the varicocele was noted, but the CI had recurrent pain upon resumption of military activities.  

During MEB examination (recorded on DD Forms 2807-1 and 2808) performed on 5 December 2006, 5 months prior to separation, the CI reported persistent pain.  A persistent varicocele was noted on examination.  At the MEB NARSUM examination dated 4 January 2007, 4 months prior to separation, the CI reported chronic pain aggravated by activity and relieved by lying down.  The examination referenced an evaluation done by urology on 13 December 2006 which showed a small recurrent varicocele on the left and an otherwise normal examination.  

At the 14 February 2007 VA Compensation and Pension (C&P) genitourinary evaluation, 3 months before separation, the CI reported persistent pain.  A small persistent varicocele was noted and the pain attributed to this.  The examination was otherwise unremarkable.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left testicular pain condition 20%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the residuals of left varicocelectomy condition 0%, coded 7599-7525, (analogous to epididymo-orchitis), based on the C&P examination 3 months before separation, citing no evidence of long term drug therapy, 1-2 hospitalizations per year, or intermittent intensive management.  The panel observed that there is no specific code for varicocele pathology in the VASRD.  The panel considered the use of a code for a residual scar, but noted that the pain was consistently attributed to the residual varicocele and not post-operative scar tissue.  No route to a rating higher than the 20% adjudicated by the PEB was found.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic left testicular pain condition.  

Contended PEB Conditions:  Depressive Neurosis/Gastroesophageal Reflux Disease (GERD).  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions was profiled nor implicated in the commander’s statement.  Both were judged to meet retention standards.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic left testicular pain condition and IAW VASRD §4.71a and §4.115, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended Depressive Neurosis and GERD conditions, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170206, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005221, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
Enclosure